Sleep and Mental Health
Today we’re joined by Andrew Holmes, Owner and Founder of Sleep Efficiency. Andrew has over 15 years of experience in sleep diagnostics and PAP therapy. Andrew founded Sleep Efficiency here in Ottawa and has been providing individuals with take-home sleep testing since 2015. Today, Andrew will be shedding some light on the affect sleep can have on mental health, different types of sleep disorders, and he will provide tips on how to improve sleep hygiene.
I think it’s fair to say that many people may not fully realize how much sleep can affect their mental health. Can you walk us through some ways that sleep can either help or hinder a person’s mental wellness?
A: Absolutely, sleep is really a new field of study, comparatively speaking; they didn’t really think much was going on up until maybe the 60’s or so where they actually realized there was a lot more brain function happening when we slept than what was once thought. Prior to about 1959, sleep was looked upon as this sort of dormant period where it was involuntary- we know we had to do it but we didn’t really know why. We didn’t really know what the benefits were, although it was absolutely 100% necessary. Around 1958-1959, they started doing a couple of EEG tests, which are Electroencephalogram, and that’s where they realized that the brain is actually quite active during sleep and where sleep cycles kind of came from.
Sleep cycles are 90 minutes in duration where we go through the lightest stages sleep to the deepest stage of sleep and we close out with the REM period. That 90-minute cycle kind of repeats itself over and over and over again throughout the course of the night. Each one of those stages of sleep is really responsible in giving our body back something. Our slow-wave sleep is responsible for physical restoration; growth hormones release, muscle and tissue regeneration take place- so if you built a deck or went for a really long walk, or you’re coming from an operation, that’s when your body physically heals itself.
When we go into our REM sleep, that's responsible for our cognitive restoration, our mental horsepower where we have memory consolidation take place, so things that we’ve learned in the beginning of the week kind of consolidate into our long-term memory, so our memory recall this kind of impacted by that. So again, all of this different brain function that's happening while we're sleeping is necessary and it impacts our physical, emotional, and mental health on a great scale. What you want to consider is, you know, “Am I getting enough sleep?” “What is that kind of ‘magic hour’?” and “Is my sleep quality in nature?” There are a few different things that you want to examine there.
Something I was hoping you could touch on as well is sleep disorders. Are there a lot of different types of sleep disorders, and how would a person go about receiving a diagnosis for one?
A: Yes! There is actually over 100 different types of sleep disorders and I know a little bit about all of them and a lot about most of them. Basically, there are some primary sleep disorders- things such as sleep apnea or restless leg syndrome, periodic leg movements then there's this whole subset of sleep disorders that are kind of categories into what they call parasomnias. Parasomnias are abnormal things that are happening throughout the course of the night, the most common one would be sleepwalking for instance. Another would be sleep eating; some people actually don't realize it but they’re fully asleep and they actually get up and then in an unconscious state make a full meal. They don't really understand why there's so much weight gain going on, but that's what's happening, they’re getting up in the middle of the night and preparing themselves a meal which can be quite dangerous, obviously. You can imagine somebody's actually cutting up vegetables or switching on a stove or something like that- it can be quite scary. So yeah, there's all these different types of sleep disorders.
With mental health it's really kind of a bidirectional relationship. People who have issues with mental health often have really poor sleep habits and people have poor sleep habits can potentially exacerbate any underlying health conditions, one of them being mental health. We really wanted to focus in on the amount of sleep; if we were to look at getting best optimal sleep for peak performance to make sure that you're well rested, to make sure they were able to handle anxiety levels next day, to be able to make sure you're able to handle the stress that’s thrown at you, seven hours is kind of the new research that just came out. I actually did the segment on 580CFRA last week and we talked about this. It used to be 7 to 9 hours to be optimal for peak performance (and that's talking about adult specifically, you want to make sure that we're capturing the right age group here, so if you are let's say a teenager early teens, you probably want to be somewhere between 9 to 11 hours of sleep) if you're an adult let's say over the age of 19 or 20, 7 hours seems to be that magic number now.
If you were to just do a simple Google search of what sleep hygiene is, that would be something that maybe some of the patients that would be listening to this could actually absorb some good takeaways and things that they could implement almost instantly; a lot of them are anyway. Sleep hygiene is kind of defined as best sleep practices. It doesn't mean having a shower before you go to bed to make sure you're nice and clean, it's those standard things that you do on a daily basis that will set you up for the most success when it comes to sleeping. One of the most important ones would be going to bed at the same time and getting up at the same time. We really want to keep that [consistent] and on the weekend, of course, allow yourself maybe an hour to sleep in or something like that. If we start shifting our bedtime and our rise time on a daily basis or even two or three times a week, what can happen is you can create a sleep debt for yourself. Bedtime and rise time is absolutely critical. Let's say you should make a strong decision that at 11:00 o'clock I'm going to go to bed and 7:00 o'clock every single morning you wake up and get your feet on the floor. If you end up sleeping in a little bit too much that day, then you’re going to impact your ability to fall asleep that night. if you go to bed too late and you have to get up early, maybe you're going to take a nap in the afternoon and now that's going to affect your sleep onset latency for that particular evening as well.
Just like when we were kids, sleep craves routine- it wants to be in that same kind of time frame. We talked briefly about sleep cycles and those are all kind of factored into this basic sleep hygiene tactic of same bedtime, same rise time. If we keep that consistent, our body will naturally wake us up and bring us out of a lighter stage of sleep because it's used to waking up and that sleep cycle will kind of exit itself naturally versus if you're going to bed and waking up at different times, you can wake up out of a slow wave sleep which is our deepest form and what you create there something called sleep inertia which is a sleep drunkenness, a sleep grogginess; you can actually wake up feeling exhausted and it can take two to three hours because you were ripped out of a sleep cycle that you weren’t actually able to finish. Again, one of the biggest things you want to look at is going to bed at the same time and getting up at the same time.
Another good one for sleep hygiene best practices would be exposing yourself to daylight. This impacts our mental health as well- Seasonal Affective Disorder happens with the winter months -also called Winter Depression. Exposing yourself to daylight throughout the daytime is going to [help]. Light enters your eye via the retina, and it impacts we call your circadian rhythm. Your circadian rhythm is responsible for your sleep-wake cycle; it’s your body’s internal clock. The more exposure to natural light and daylight you can absorb through the daytime, it's going to put you in a position to be more tired in the evening. Alternatively, as well, you should be adjusting all the lights in your house maybe an hour two before bed you know.
Having a phone in your bedroom, or a TV is not a great sleep practice. It may be comfortable, and I know lots of people do it but a lot of studies show now that blue light actually delays the release of melatonin, which is a sleep inducing hormone. Your body is actually trying to fall asleep and try to release melatonin to your system to allow sleep onset to take place, but if you've got a phone staring in your eyes, it’s like shining a flashlight right into your eyes and that's going to delay the release melatonin, and in turn not allow you to fall asleep easily. National Sleep Foundation is a great source to go to, just type in sleep hygiene best practices. It all talks about the impact of caffeine, when we should eat our meals (not too close to bedtime), all of these different sleep practices, and again, a lot of them are things you can implement almost immediately, and they'll end up having a significant affect on your sleep in a very short period of time.
Just to touch on the technology a little bit, is there a specific time frame that you would recommend someone shutting off their phone or turning off the TV before they're trying to actually get to sleep?
A: The general rule of thumb would probably maybe an hour to two before bedtime. You almost want to kind of go with an old-school approach, maybe grab a book, turn down all the lights in your house or listen to some soft music, have a nice bath- routine is key. [You want to make sure] you're doing it consistently, nightly. You want to kind of set yourself up so that when it gets to the bedroom your body knows it's there to sleep; it's ready for it and you’ve done some steps that will allow your body to kind of unwind.
One other thing as well is we shouldn't be doing any of these types of things in the bedroom. If you want to read a chapter or something like that in bed, sure. But your bedroom should be used strictly for sleeping and sex, I suppose. All other activities should be really taking place outside of the bedroom. You don't want to associate any other activity like studying, any of your office work or anything like that with the bedroom. You want your body to know that when it arrives in that environment, it knows it's there to sleep and it's going to do that. With the pandemic over the last couple of years, a lot of people are working from home now and maybe they don't have the opportunity to work out of their basement and they have to make it work out of a one-bedroom apartment, so again these are guidelines, they’re not musts but it's what would set you up for optimal success for quality sleep.
Can you walk us through how Sleep Efficiency’s take-home testing differs from the traditional sleep clinic testing where you have to go in and stay overnight?
A: There's been a bit of a shift in the way Healthcare is being delivered right now, and it needs to. The population is going through the roof and a lot of the hospitals, a lot of the outpatient testing and things like that kind of still operate in an analog style; you’ve got to go to the building to get it done, it's got to be on a very specific date, so “We're going to book you for a test six months from now on Wednesday at 9:00 o'clock at night” a lot of people have a hard time committing to that. What we offer is diagnostic take home sleep testing where this is all done from the comfort of your own bed. It's specifically looking for sleep apnea though, so if the indications are that maybe some of your symptoms are that you wake up gasping for air, you’re excessively tired through the daytime, morning headaches, these types of things would indicate that maybe sleep apnea is the culprit then that's what we specifically test for; any sort of respiratory related sleep disordered breathing. If you have issues like insomnia for instance, or you want to investigate any sort of those parasomnias that I talked about (e.g. REM behavior disorder) then your hospital is a lot more comprehensive and they still serve a wonderful purpose. However, the wait times for sleep tests (in hospitals) are in excess of six months, whereas with Sleep Efficiency, we're able to offer patients sometimes a next day appointment, and if not, definitely within a couple of days. It's the notion that they come to the office, they pick up one of our kits, they go home, they sleep with it in the comfort of their own bed, and it's all around their sleep schedule- whatever time they want to go to bed. You know, a lot of shift workers can't go to a sleep test at the hospital because their shift maybe starts at 10 or 11:00 o'clock at night and they work all through the night, so we kind of cater to a large group that would prefer that. A lot of patients with PTSD don't like the idea of sleeping in a hospital- I don't like the idea of sleeping in a hospital, to be honest, on a bed that's been slept on 1,000 times before with overhead pages going. It's not really conducive to a good night sleep.
Sleep Efficiency was kind of born about 4-5 years ago where I saw the need to offer a different type of service where we could offer a more timely service. You want to think about as well, if you're waiting for a sleep test and it's going to take six months, we can alleviate some of those people that don't need to be in that lineup. We can rule out a lot of people in a very short period of time so that will actually allow access to those who need hospital-based testing a lot sooner; we can kind of get rid of the ones that are there that don't need to be [tested at the hospital]. Of course, and it's an elective service, so they think maybe somethings wrong, but it's not as critical. The point I'm trying to make here is you shouldn’t maybe have the 70 or 75 year-old in the same lineup is the 19-year-old. If the 75-year-old has some serious cardiac disease and they have severe sleep apnea, it can put them in an increased risk of heart attack, stroke and congestive heart failure. If the 19-year-old has just got some sleep phase syndrome where they have problems regulating their bedtime and rise time and it's just simple behavior modifications, those two people shouldn't be in the same line up to get the same kind of testing done. We want to make sure that the people who truly need hospital-based sleep testing are getting it done, and then we can help out in that capacity- and we are, we’ve seen several thousand patients now over the last couple of years.
If anyone is interested in contacting you what would be the best way to go about doing that?
A: Our website is probably the best point of contact, all the information is there. It's www.sleepefficiency.ca. Patients can actually self-refer; we don't require a referral from the physician, although we do require a family physician involved for follow up. They can actually go directly to our website, www.sleepefficiency.ca, they can click the request sleep test, submit their own referral and we can offer them appointments as quickly as it just a couple of days later.
Thank you so much for joining us today Andrew!
Sleep & Mental Health
If you haven’t experienced it first-hand, it may be difficult to connect sleep-related issues to mental health concerns. Studies show that about 40% of patients who seek out medical help for their sleeping problems have a psychiatric condition, and between 60-90% of people with depression have insomnia. Commonly, sleep disorders go hand in hand with mental health disorders such as anxiety, depression, ADHD, schizophrenia and bipolar disorder. Sleep problems present themselves in different ways depending on which disorder the patient suffers from; for example, patients with anxiety disorders such as PTSD and OCD tend to experience insomnia, nightmares and nocturnal panic attacks, and people suffering from depression tend to experience hypersomnia or sleep apnea.
Melatonin is the chemical in the body that is released from the pineal gland which modulates sleep patterns in both circadian and seasonal cycles; it is responsible for inducing sleep. Cortisol is the hormone released by the body in stressful situations, such as moments of worry or anxiety. Cortisol offsets the balance of melatonin, which can result in trouble falling or staying asleep. Depression has been linked to imbalances in the thyroid hormones which can also lead to sleep problems.
How Sleep Helps:
Sleep patterns typically cycle between two categories: Rapid Eye Movement (REM) and “quiet” sleep. “Quiet” sleep is when you are in a deeper sleep; during this time, your body temperature drops, your muscles relax and your breathing slows. This is the time that helps to boost your immune system. REM sleep is the part of sleep where people dream. During this time, your breathing, muscle tension, heart rate and temperature are similar to the levels present when you are awake. REM sleep is critical in enhancing learning, memory and emotional health.
Be Aware of Substance Intake
Caffeine is a substance that many of us consume daily - it is a stimulant that helps to keep us awake and alert. Try to cut out as much as possible, even if it is just one less cup a day. Alcohol is another common substance that many of us consume regularly, however not everyone is aware of the effect it has on our sleep; while alcohol initially depresses our nervous system, eventually the effects wear off which causes the sleepy feelings to fade and sleep to be disrupted. Nicotine is another commonly used substance. Nicotine is a stimulant, so consumption before bed should be avoided in order to obtain a good night’s rest.
Increase Physical Activity
Physical activity is always recommended for a healthy lifestyle and mental health, as well, physical activity has been proven to improve sleep quality. Make it a habit to include 30 minutes of aerobic activity into your daily routine. Activities such as yoga are also recommended before bed to help wind down after an eventful day.
Improve Your Sleep Environment
It is important that your brain associates your bedroom with sleep, so try to keep the area designated for just that. Having a television in your bedroom may be convenient, but it can hinder your ability to fall asleep easily. Try to avoid screens as much as possible leading up to falling asleep. Setting a schedule for yourself regarding wake up and bedtimes has also been shown to help improve sleep patterns.
Speak to Your Doctor About Medication
Currently, medication is available that helps with depression and irregular sleep, however the medication for one can often worsen the symptoms of the other. Speak to your doctor about the symptoms you have been experiencing, and work with your medical provider to find the medication that works best for you.
Cognitive Behavioural Therapy is recommended both for individuals who are having problems sleeping, and those suffering from mental health disorders. CBT helps to reframe negative thoughts that contribute to depression or anxiety and poor sleep. CBT-I is a specialization directly devoted to the treatment of insomnia. Ask your mental health professional if they have experience with CBT-I or if they know someone who does.
Dr. Diana Garcia
Dr. Diana Garcia has over 20 years of experience in the field of psychology. She has provided psychological and counseling services in Ontario, and the states of Pennsylvania, and Florida